PB2157: AUTOSCT IN PATIENTS WITH MULTIPLE MYELOMA AND DIALYSIS-DEPENDENT NEPHROPATHY
Authors: Ekaterina Karimova, Eugenia Zhelnova, Konstantin Yatskov, Diana Gagloeva, Ekaterina Zotina, Ekaterina Grishina, Vytaly Yakimetz, Eugenia Paramonova, Elena Misyurina
Journal: HemaSphere (2023)

Topic: 14. Myeloma and other monoclonal gammopathies - Clinical Background: Renal failure is a common complication of MM, and it is often associated with a poor prognosis. AutoSCT is a standard therapy for young patients, but it is usually avoided in a group of patients with dialysis-dependent nephropathy because of possible higher toxicity, associated with required high dose chemotherapy. Aims: to evaluate the efficacy and safety of autoSCT in patients with dialysis-dependent nephropathy by analyzing our own experience Methods: During 2015-2022 13 patients with dialysis-dependent MM underwent AutoSCT in MCH №52: 8 (62%) male and 5 (38%) female; median age was 52 years (43-65). 2 of them got tandem transplant procedure. All the patient had stage III by Durie-Salmon criteria. According to ISS criteria 11 (92%) pts had stage III, 2 (8%) – stage II. Cytogenetic bone marrow investigation has been conducted in 9 patients, 2 of them had cytogenetic abnormalities: 1 (8.3%) - del p53, 1(8,3%) - 1q21 gain. Induction therapy was performed with standard protocols: 7 (54%) pts were treated by 1 line therapy courses (46% VCD, 8% VRD), 6 (46%) pts got 2 line therapy. By the end if induction chemotherapy 4 (31%) pts reached CR, 6 (46%) –VGPR, 3 (23%) – PR. Hematopoietic stem cell mobilization was performed by Cyclophosphamide 4 g/m2 (5 pts – 38%) and 3 g/m2 (8 pts – 62%) followed by G-CSF 5 mkg/kg. All SC apheresis were effective. Melphalan 140 mg/m2 was used as pre-transplant conditioning in 10 pts (78%), in 3 cases Bendamustine 200mg/m2 was added to Melphalan (-1 day). Mean account of transfused CD34+ cells was 4,4*10^6. Results: Mean engraftment period was 17 days (11-35), thrombocyte level increased within standard period, but 3 patients had persisting thrombocytopenia during more than 6 months, that required hemotransfusions 1-2 times a week, 1 patient died because of hemorrhagic stroke after 12 months after autoSCT. AutoSCTs were accompanied with following infectious complications: mucositis 1-2 st 5 pts (38%), 3-4 st -8 pts (62%), necrotic enteropathy - 9 pts (69%), pneumonia -3 pts (23%), sepsis – 3 pts (23%). HSV 1,2; HV 6 and CMV reactivation was proved in 4 pts (31%). The patients also had following non-infectious complications: gastrointestinal bleeding – 1 pt, toxic cardiomyopathy – 1 pt. TRM was 0%. According to the results of control investigation on +100 day after autoSCT all the patients had deeper response: 7 (54%) reached CR, 5 (38%) – VGPR, 1(8%) – PR. 7 pts (54%) showed renal response and became independent of dialysis. Long –term outcome (median follow up was 39 months (4-71): 5 (38%) pts remain CR, 3 pts (23%) relapsed early, 2 of them died on progression. 4 pts (31%) had late relapse. 7 (54%) remain dialysis-independency (1 of them underwent kidney transplantation). Median overall survival has not been reached. Three-year OS was 77%. Three-year progressive-free survival was 46% (pic1).Summary/Conclusion: AutoSCT (including tandem) could be and should be performed as consolidation therapy in patients with MM and dialysis-dependent nephropathy. Decrease of melphalan (140 mg/m2) with/without bendamustine (200 mg/m2) allows to keep acceptable toxicity level in dialysis-dependent patients. AutoSCT is a chance to improve renal response and become dialysis independent, even if it has not reached during induction therapy. Keywords: Autologous hematopoietic stem cell transplantation, Renal failure, Multiple myeloma